OrganizationActive
Customedica Pharmacy Inc
NPI 1508162454 · Compounding Pharmacy · Eagle, ID
Provider details
- NPI number
- 1508162454
- Entity type
- Organization
- Primary specialty
- Compounding PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Shah Afshar, Cheif Pharmacist(208) 939-8008
Specialties & taxonomies
Suppliers
- Pharmacy333600000X
Suppliers
- Community/Retail Pharmacy3336C0003X
Suppliers
- Specialty Pharmacy3336S0011X
Suppliers
Profile Score
Detailed profile(82/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
15 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
149 W State St Ste 101
Eagle, ID 83616-4911
Phone: (208) 939-8008
Fax: (208) 938-1067
Street-level locationGet directions
Mailing address
149 W State St
Eagle, ID 83616-4901
Other names (DBA / former)
- Doing business as
- Customedica Compounding Center
Registry dates
- Enumerated
- 2011-02-09
- Last updated
- 2016-08-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.